Individual
DR. LYNETTE MARIE WIEST
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PSY. D.
Contact information
Practice address
121 JACKSON ST, NEWNAN, GA 30263-1572
(770) 251-5873
(770) 304-2201
Mailing address
121 JACKSON ST, NEWNAN, GA 30263-1572
(770) 251-5873
(770) 304-2201
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2610
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00964598A
—
GA
Enumeration date
05/04/2006
Last updated
07/09/2007
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